Determination of the Optimal Volume of 0.5% Ropivacaine in Single-injection Retroclavicular Brachial Plexus Block for Arthroscopic Shoulder Surgery: A Phase I/II Trial
Authors' conclusion
A single-injection retroclavicular brachial plexus block using 25 ml of 0.5% ropivacaine produced consistent block success with a minimal hemidiaphragmatic paralysis rate
Study context
- Population
- Patients undergoing arthroscopic shoulder surgery with single-injection retroclavicular brachial plexus block
- Participants
- 54 patients
- Comparison
- Escalating volumes of 0.5% ropivacaine (15 to 40 ml) for single-injection retroclavicular brachial plexus block
- Outcome
- Phase I: complete or partial hemidiaphragmatic paralysis (ultrasound); phase II: block success (total sensorimotor score ≥12 and total sensory score ≥3, manual sensorimotor testing)
- Follow-up
- 30 min after block completion (phase I)
Methodological detailsseamless single-arm, exploratory, Bayesian optimal interval design (volume escalation), Bayesian optimal phase 2 design (volume expansion)
- Seamless single-arm
- Exploratory
- Bayesian optimal interval design (volume escalation)
- Bayesian optimal phase 2 design (volume expansion)
Main finding
As reported in the abstract
Maximum tolerated volume
35 ml
Hemidiaphragmatic paralysis rate at maximum tolerated volume
0.09
95% CrI 0 to 0.29
Optimal biologic volume
25 ml
Block success rate at optimal biologic volume
1.0
95% CrI 0.95 to 1.0
Safety
Hemidiaphragmatic paralysis at optimal biologic volume (25 ml)
- Negligible hemidiaphragmatic paralysis rate
- 0.01 (95% CrI 0 to 0.06)
Original publication
Determination of the Optimal Volume of 0.5% Ropivacaine in Single-injection Retroclavicular Brachial Plexus Block for Arthroscopic Shoulder Surgery: A Phase I/II Trial. Anesthesiology. Published 17 July 2024. doi:10.
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